Salinas >> Shortly after three Natividad Medical Center trustees announced last month they would resign April 1, then-board chairman Roy Robbins predicted opening up affiliation talks with Salinas Valley Memorial Hospital to a variety of interest groups would be "problematic."

Weeks later, as the hospital board on Friday conducted its first meeting without Robbins and fellow trustee alumni Margaret Eaton and Rodney Braga, that prediction is looking ever more prophetic.

Supervisor Simon Salinas acknowledged it was taking considerably longer than he anticipated to come up with a workable response to Salinas Valley Memorial's January proposal to begin formal affiliation talks. Salinas, who in February was named to an ad-hoc committee charged with responding to the proposal, said the challenge of incorporating input from a range of stakeholders from Natividad leadership to its medical staff and other union-represented employees was more "complex" than expected.

While county officials initially expected the process to take less than a month, nearly two months later Salinas now says the supervisors could be offered a series of options for how to respond by April 22.

On Tuesday, the supervisors are scheduled to discuss Natividad campus property terms in closed session, which is believed to be linked to the affiliation consideration and possible legal issues around any transfer of Natividad's assets to an independent hospital authority as proposed by Salinas Valley Memorial. While Salinas Valley Memorial CEO Pete Delgado is listed as negotiating party, a hospital spokeswoman said Delgado had not been in any talks with county officials, and hospital officials were still waiting for the county to respond to the affiliation proposal.

When they announced their resignations, Robbins, Eaton and Braga expressed frustration with the restrictions of county oversight, and urged county officials to allow the hospital to pursue either independence or affiliation to allow more autonomy.

Robbins said the trio had been considering resignation for months, but wanted to finish up several key initiatives such as earning the trauma center designation, starting affiliation talks and conducting an evaluation of CEO Harry Weis before leaving. The trio's resignation followed that of former hospital board chairman John O'Brien, who left in October. All four were appointed in 2009.

"I think we were all pretty well frustrated with the pace of how things were happening," Robbins said. "I think all of us expected to move forward with gaining independence from the county or affiliation. We all gave (the hospital) a lot of time and believed we would make more progress."

Robbins said he's convinced Natividad's future will be dependent on how quickly the hospital can complete a partnership that allows more freedom to continue its financial rebound under the demands of health reform, and finally "get the county out of the (hospital) business" in the process.

Reform "is going to be a challenge for everyone, not just Natividad," he said. "We're in pretty good shape financially, but there are cautionary yellow flags out there. We have two or three years before we run out of cash, and we have to plan for the day when both volume and reimbursement drop."

At Friday's board meeting, led by new chairman Dr. Kelly O'Keefe, Weis acknowledged "big changes" coming under health reform but also pointed to the opportunity it offered to reduce the numbers of uninsured in the state for the first time in many years, and called it a "really big quality of life improvement for the community." He said the number of county residents who purchased private insurance through the state's insurance exchange — Covered California — is not yet known, but noted more than 4,600 locals now have Medi-Cal coverage under the Affordable Care Act.

Weis also reported he was in the process of finding candidates for the four open board spots.